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Canine Autoimmune Hemolytic Anemia (AIHA & IMHA) - looking for input on last step off meds
| My 3 and a half year old standard poodle was diagnosed with idiopathic AIHA last December 2008. He required 3 day hospitalization and blood transfusions, but since then has made a very good recovery. We had one scare that he might be relapsing (a dip in PCV), but in retrospect I think it probably was a laboratory error. At this point he is a healthy dog. We are keeping him on a maintenance dose of 2.5 mg prednisone daily. He's about 60 lbs, and the vet really doesn't think it can be doing much but totally respects our decision to keep him on it for now. I've heard that its wise to keep dogs on medicine for at least 1-2 years, so wondering whether people think that low dose of prednisone can be protective against an immune crisis should he encounter some trigger again??? |
| Leslie Philly |
| Leslie, Congratulations on your Poodle's recovery! What color his his coat? I have a preference for the black but probably because I have black Giant Schnauzers. I think Poodles rival Giants in intelligence. When you look at the dosages of prednisone you will see that they break down into a few rough categories. What you used while he was very ill was considered an immunosuppressive dose. This was probably upwards of anywhere from 40-100 mg a day? This very high dose suppresses all elements of the immune system and also causes havoc in many body systems that don't like that flood of cortisol. But for all the negatives, prednisone is still a wonder drug, saving lives. Now you are at what might be called a sub-clinical dose. This dose doesn't suppress the immune system as much and may even mirror what the body would provide for itself (via the adrenal glands) in the way of cortisol. As you have decreased the prednisone very gradually, you were attempting to wake up the adrenal glands. They responded to the high doses of prednisone by saying "ok, guess you don't need me to do my job now, I'll just go to sleep until you wake me up." If the dose of prednisone is not decreased slowly and carefully and the adrenals are not producing sufficient cortisol, there can be serious effects like collapses. Vets and human doctors are well versed in how to decrease prednisone carefully and I suspect your vet did this very carefully and correctly from what you have said. Dr. Dodds has variably recommended that dogs who have AIHA may always need to be on a small dose of prednisone. My experience is that we were able to wean Chance off of all drugs (except Soloxine, that is lifetime) and there were no negative side effects. From a clinical viewpoint, if you want to make sure the adrenal glands are functioning properly, there is a test that can be done to insure they are working. If this test shows proper function, then no, prednisone would no longer be needed. However, in general, if a dog is weaned off of prednisone and makes that final decrease to nothing and seems fine, then that is proof positive that the adrenals woke up. Some dogs may need to remain on a small dose because of the adrenal glands, or they may have allergies that respond well to pred or they may have a bit of arthritis or a form of digestive colitis. Any number of conditions respond well to small dose pred. The side effects are less, but there can be some. Your vet would be the person to tell you exactly what they would expect them to be. *If this were me* and I had a very young dog like this I would be apt to want to remove all drugs. But I would also continue to be much more careful about regular vet checkups. I would probably do a full CBC and chem screen twice a year and make routine visits 4 times a year just to make sure everything is ok. If something is going to happen again, if I were to do these things, I would have a better look at the progression. I would continue to be very cautious about any vaccinations (except the legally required rabies) and I would make sure that my dog is on the best diet I can provide. To go even further, I would probably try to avoid any kind of stressors to this dog for a lifetime. I would not use boarding kennels for instance. Dr. Dodds believes that there are many causes for immune problems. Stressors, hormones, vaccinations, viruses and environmental pollutants are high on her list. If this were an older dog, over 10 say, I might apt to estimate their lifespan and think that they may be benefiting from the low dose pred and just maintain it that way. But it's all personal choice. In the end it's your choice and comes down to your level of comfort with these risks. If you like your vet and trust him/her, then that can be of comfort to you that if you make this choice, they are just an office visit away. my best patrice |
| Patrice NYS |
| Patrice, Thank you so much for this post! We are in a similar situation and your knowledge and opinion helped again, like so many times before. I did not know that there is a test to check if the adrenal glands are working. I will definitely look into that. Thanks again, Brigitte |
| Brigitte BC Canada |
| As so often the case great question and great response. My hat goes off to the Giant Schnauzers mom once again. Like Brigitte we are not at this juncture yet, hopefully sometime in our foreseeable future, and Patrice your response helps immensely. Ron & Cooper |
| Ron Florida |
| I will definetely be asking my vet about this test when I see her on Wed! What Patrice said is very similar to what I was told by the specialist. The plan with Calypso is to wean off all the meds if she tolerates it. The specialist said she has been able to do this in other young dogs that their seems to be no underlying conditions. Patrice, can this Cortisol test be done while they are still on Prednisone and/or Cyclosprin? Thanks, Wendi |
| Wendi Ohio |
| Thank you Patrice, you answered some questions for me, as charlie is going off pred soon... he is a younger dog, and it makes sence. His recovery has gone so well. Carol |
| Carol |
| The test is called the ACTH response test. Your dog may not be on any type of prednisone or other cortisone drug prior to the test. I am not sure but I believe it is about 2-3 weeks. A drug is injected that stimulates the adrenal glands and then the blood is monitored to see if they respond appropriately to this stimulation. This would take approximately two hours at the vets' office. If there is sufficient cortisol produced, then the test is negative and the vet will advise you that the adrenal glands are working properly. This test is used to diagnose dogs that have Cushings' Disease. This is when the body produces too much cortisol and they want to determine the cause of that. Obviously, we are giving our dogs TOO MUCH CORTISOL via prednisone, so they in effect have a form of Cushing's Disease, only it's artificially induced. This is called Iatrogenic Cushings. True Cushings' Disease is treated with drugs for a lifetime. These dogs have symptoms like ours have on high doses of prednisone but it never goes away. The condition we want to know about as we decrease the dose of prednisone is Addison's Disease, or not enough cortisol being produced by the adrenal glands. In many dogs with true or primary Addison's Disease they also have a problem with maintaining proper potassium and sodium levels in the blood. These dogs are generally in serious crisis and were very ill to begin with. The cause for this is more likely to be a tumor. But this is not the case with Iatrogenic Addison's Disease. These dogs generally have a suppressed adrenal gland function for producing only the glucocorticoids and their potassium and sodium levels are ok. This condition starts with artificially high levels of cortisol from high dose prednisone and happens as that dose is decreased. Most often when the prednisone is decreased, the adrenal glands will wake up again. I can't say for sure if clinically any dogs that have been treated with high dose prednisone for AIHA have ever gone on to have a form of Addison's disease that required continued prednisone or not. I don't remember it ever being mentioned here on this list. I suspect it is very rare. Most dogs' adrenals "wake up" just fine and no test is needed. You can discuss it with your vet, but I feel they may discourage you from doing this test. But they are the best professionals to determine if this is truly necessary. my best patrice |
| Patrice NYS |
| Hi Patrice, This isn't the first time that you have been so helpful with information in the past 9 months. I wonder if you a veterinarian yourself (?) My dog is a white male - I needed to change it up somewhat after my sweet black female standard died a few years back. So it sounds like your opinion is that the very low dose prednisone is indicated if the adrenal glands are compromised (or for other medical conditions), but not so much for preventing another relapse of AIHA in an otherwise seemingly healthy dog. Once again, thanks for taking the time to write such a thorough response to my question! Leslie |
| Leslie Philly |
This thread was discussed between 06/09/2009 and 07/09/2009
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